=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326388786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID E MARTIN PTA, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2013
-----------------------------------------------------
Last Update Date | 06/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5120 DIXIE HWY STE 102
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40216-1775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-448-0931
-----------------------------------------------------
Fax | 502-448-0918
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5120 DIXIE HWY STE 102
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40216-1775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-448-0931
-----------------------------------------------------
Fax | 502-448-0918
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A02869
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------